Synopsis

Source of validity: Scientific
Rating (out of 5): 4

Bicarbonate (usually administered as intravenous sodium bicarbonate) is scientifically validated for use in certain types of poisoning, particularly those involving toxins that cause metabolic acidosis or cardiotoxicity. The most well-established indications include poisoning with tricyclic antidepressants (TCAs), salicylates (aspirin), and certain other drugs that cause sodium channel blockade or significant acid-base disturbances.

In TCA overdose, sodium bicarbonate is used because it can reverse cardiac toxicity by narrowing the QRS complex and correcting acidosis, both of which are life-threatening complications. In salicylate poisoning, bicarbonate promotes "alkalinization of urine," which enhances the renal elimination of salicylates, and also helps correct acid-base imbalances caused by the toxin.

The evidence supporting these uses comes from decades of clinical experience, case reports, animal studies, and controlled clinical trials. Guidelines from toxicology societies (such as the American College of Medical Toxicology and the American Academy of Clinical Toxicology) specifically recommend bicarbonate therapy in these poisonings. However, bicarbonate is not a general antidote for all poisons; its role is limited to specific scenarios where its mechanisms (alkalinization, correction of acidosis, sodium loading) are beneficial.

Therefore, the use of bicarbonate in poisoning is scientifically established, but its application is targeted rather than general. The evidence rating of 4 reflects strong, specific, but not universal, support in the medical literature.

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